Organization
LD-TUPELO, LLC
Active
Other names
Premier Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN S DAIGNEAULT BA, MA (ADMIN DIRECTOR)
(256) 783-9468
Entity
Organization
Contact information
Practice address
1763 CLIFF GOOKIN BLVD, TUPELO, MS 38801-6723
(662) 842-2802
(866) 251-3105
Mailing address
1763 CLIFF GOOKIN BLVD, TUPELO, MS 38801-6723
(662) 842-2802
(866) 251-3105
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2017
Last updated
07/07/2023
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